Radical radiotherapy for carcinoma of the cervix--the Zimbabwean experience

Carcinoma of the cervix accounts for over 30% of all female malignancies in Zimbabwe. Patients treated with radiotherapy tend to have advanced disease. This study examines some presentation patterns, radiotherapy treatment parameters, outcomes of treatment and identifies some prognostic factors in this set up.

Retrospective study.

The study was undertaken on all patients (273) who presented to the Parirenyatwa Hospital Radiotherapy Centre (RTC) between November 1990 and December 1991 with a diagnosis of cervical carcinoma. Of these patients 93 were suitable for radical treatment and they were studied.

Complete remission rates in relation to total dose given and stage of disease, incidence of acute complications, local recurrence and development of metastases.

Of the 93 patients studied 72 (77.4%) were Stages I and II and 21 (22.6%) were stage III. Fifty nine percent of the patients gave a history of three to eight months symptom duration and 21.5% symptom duration longer one year. The mean length of follow up time was 13.4 months. The overall complete remission (CR) rate 49%. Ninety seven percent of patients achieving a CR had received 70 Gy or more as total dose to Point A. Patients with both pelvic wall and lower one third vaginal involvement (Stage A + B) did more poorly than other Stage III patients. Acute complications were mainly mild and seen in patients whose overall treatment time was under seven weeks. Most recurrences and metastases occurred within one year of completion of treatment.

It is only a minority of patients (34.1%) that present to the Radiotherapy Centre with cervical carcinoma who are suitable for radical treatment. These are patients who become aware of their symptoms early. Treatment achieves a good complete remission rate. Follow up of treated patients is poor. The sub group of patients with Stage III A + B must be recognised for their poorer response compared to other patients with Stage III disease.